CONTROL OF ASTHMA AT THE 3RD-LINE PULMONARY DISEASES CLINICS

(3RD LINE PDC) ACCORDING GINA (GLOBAL INITIATIVE FOR ASTHMA)

PARAMETERSBİLUN GEMİCİOĞLU 1 FÜSUN YILDIZ 2 MEHMET POLATLI 3 SİBEL ATIŞ 4 A.BERNA DURSUN 5 FERDA ÖNER ERKEKOL 5 HATİCE TÜRKER 6 BİRSEN OCAKLI 6 GÜNGÖR ÇAMSARI 7 AYGÜN GÜR 7 SEÇİL KEPİL ÖZDEMİR 8 ÖMÜR AYDIN 8 ÖZNUR ABADOĞLU 9 ARİF ÇIMRIN 10 MUSTAFA LEVENT ERKAN 11 HAKAN GÜNEN 12 ÖZLEM GÖKSEL 13

1Pulmonary Diseases, Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, 2Pulmonary Diseases, Kocaeli University, Faculty of Medicine, Kocaeli,3Pulmonary Diseases, Adnan Menderes Univerity, Faculty of Medicine, Aydin, 4Pulmonary Diseases, Mersin Univerity, Faculty of Medicine, Mersin5Allergy, Ataturk Chest Diseases and Thoracic Surgery Education and Research Hospital, Ankara6Pulmonary Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul7Pulmonary Diseases, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul,8Allergy, Ankara University, Faculty of Medicine, Ankara9Allergy, Cumhuriyet University, Faculty of Medicine, Sivas10Pulmonary Diseases, Dokuz Eylul University, Faculty of Medicine, Izmir 11Pulmonary Diseases, Ondokuz Mayis University, Faculty of Medicine, Samsun12Pulmonary Diseases, Inonu University, Faculty of Medicine, Malatya 13Pulmonary Diseases, Izmir Ataturk Education and Research Hospital, İzmir

Study Centers

GINA 2007 and Control ConceptCharacteristic Controlled

(all of the following)

Partly controlled(any measure present in any week)

Uncontrolled

Daytime symptoms

None (0-2/week)

More than twice/week

Nocturnal awakening

None Any

Limitations of activities

None Any

Need for reliever treatment

None(0-2/week)

More than twice/week

FEV1 - PEF Normal < 80% predicted or personal best

Exacerbations None 1 or more/year An uncontrolled week

≥ 3 features of partly controlled asthma present in any week

TESTS NUMERICALLY EVALUATING ASTHMA CONTROL

Measuring test Writer Score

Asthma Control Questionnaire (ACQ) Juniper et al, 1999

0 – 6

Asthma Control Test (ACT) Nathan et al, 2004

5 – 25

Asthma Therapy Assessment Questionnaire (ATAQ)

Vollmer et al, 19990 – 4

Asthma Control Scoring System (ACSS) Boulet et al, 2004

0 – 100%

AIMS

• Preparing an easily understandable form (AACT1) questionning GINA 2007 symptom control citeria and determining some reasons for uncontrolled disease through AACT2 form.

• Validation of the new form; eatablishing its correlation with Astma Control Test (ACT) and FEV1

• Establishing some reasons for lack of control in asthma and compliance with GINA 2007 criteria in Turkish asthmatic patients at 3rd line PDC, through AACT total score.

810 asthmatics on treatment (13 3rd line PDC)

Information about demographic information,

treatment, allergy

ACT, AACT questionnaires, PFT

expert opinion on 100 cases Statistical evaluation

.

METHOD

ASTHMA CONTROL TEST™ (ACT) 1) In the past 4 weeks, how much of the time did your asthma keep you from

getting as much done at work, school or at home?1. All of the time2. Most of the time3. Some of the time4. A little of the time5. None of the time

2) During the past 4 weeks, how often have you had shortness of breath?1. More than once a day2. Once a day3. 3 to 6 times a week4. Once or twice a week5. Not at all

3) During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?1. 4 or more nights a week2. 2 or 3 nights a week3. Once a week4. Once or twice5. Not at all

Asthma Control Test™ (ACT) 4) During the past 4 weeks, how often have you used your rescue inhaler or

nebulizer medication (such as albuterol)?1. 3 or more times per day2. 1 or 2 times per day3. 2 or 3 times per week4. Once aweek or less5. Not at all

5) How would you rate your asthma control during the past 4 weeks?1. Not controlled at all2. Poorly controlled3. Somewhat controlled4. Well controlled5. Completely controlled

Total Score:

Achieving Asthma Control Test (AACT)1. In the past week, how often did you have day time asthma symptoms

(dyspnea, cough, wheezing)?a) None of the time (10)b) 1 or 2 days (8)c) 3 or more days (2)d) Every day (0)

2. In the past week, how often did your asthma symptoms (dyspnea, cough, wheezing, awakening ) wake you up at night or earlier than usual in the morning?a) None of the time (10)b) One night (4)c) 2 to 6 times (2)d) Every day (0)

3. In the past week, how often have you used your rescue bronchodilator medication (relieving dypnea) in addition to your regular daily treatment?a) None of the time (10)b) 1 or 2 days (8)c) 3 or more days (2)d) Every day (0)

4. In the past week, how much of the time have you experienced any limitation in your daily activities (work, school, exercise and house work etc.) due to asthma symptoms?a) None of the time (10)b) 1 or 2 days (6)c) 3 or more days (2)d) Every day (0)

5. Did you have any unplanned office/emergency room visits since your last visit? a) No (10) b) Yes (0)

6. Does your asthma symptoms remain contolled (asymptomatic) despite being exposed to triggering factors (smoking, perfumes, allergens, having cold, stress)?a) No (10) b) Yes (0)

7. Do you have any accompanying diseases such as allergic/non allergic rhinitis or reflux (heartburn, gastric symptoms)? If your answer is’no’, please answer question 9?a) No (10) b) Yes (0)

8. If your answer to question 7 is ‘yes’, has your accompanying disease been controlled?a) Yes (10) b) No (0)

9. Have you used your treatment regularly since your last visit (especially in the past week)?a) Yes (10) b) No (0)

10. Would you please show me the way you use your inhaler device(s)?a) Tecnic is correct (10) b) Tecnic is incorrect (0)

Total score:

BIOMETRIC AND FUNCTIONAL PARAMETERS

Parameter Value

N 810

Mean age 44.4±13.6

Mean length of the disease

9.9±9.5

Female /Male (%) 78.4 / 21.6

Never smoked (%) 68.6

FEV1 % 80.4±21.1

Expert opinionN r p

ACT 100 0,690 <0,001

AACT 1 100 0,936 <0,001

AACT Total 100 0,813 <0,001

Validations of AACT and ACT

ACT and AACT RESULTS

MEAN±SD 18,8±5.4 36,2±14,8 Best 25 50

UncontrolledPartly controlledControlled

ACT AACT1

Correlation between ACT & AACT1

R=0,846p<0,001

AC

T T

otal

Sco

re

AACT Total Score (first 5 questions)

Total correlation between ACT & AACT

R=0,758p<0,001

AC

T T

otal

Sco

re

AACT Total Score

Correlation of ACT & AACT1 with FEV1 < 80 %

R=0,847p<0,001

AACT Total Score (first 5 questions)

AC

T T

otal

Sco

re

Correlation of ACT & AACT1 with FEV1> 80%

R=0,781p<0,001

AC

T T

otal

Sco

re

AACT Total Score (first 5 questions)

ACT RESULTS ACCORDING TO SEX

P<0,003

UncontrolledControlled

ACT ACT Female ACT Male

AACT RESULTS ACCORDING TO SEX

P<0,009

UncontrolledPartly controlledControlled

AACT Female AACT MaleAACT

Skin Prick Test Findings

ACT and AACT showed no siginificant difference between skin prick test (+) and (-) subjects.

%

%

42,7 %

positivenegativenot performed

ACT; Consistency with GINA (%)

ACT1 ACT3ACT2 ACT4 ACT5

Consistent

AACT 1; Consistency with GINA (%)

AACT1 AACT5AACT2 AACT3 AACT4

Consistent

Consistency of ACT– AACT with GINA (%)

ACTAACT

Daytime Nocturnal Activity

AACT 1 + FEV1 ; GINA consistency(%)

67,9% , 60 % and 34,4% of those who are controlled, partly controlled and uncontrolled respectively, had FEV1 >80%.

AACT 6-10 answers (%)

Comorbidities were reported to be controlled in only 47% of patients having these diseasesHyperreactivity Comorbidity Irregular treatment Incorrect inhaler tecnnic

present

Consistency between AACT 6 and AACT (%)

Hyperreactivity (+)

Hyperreactivity (-)

UncontrolledPartly controlledControlled

CONCLUSION

• ACT is a practical test recommended in GINA,

• but AACT questionnaire includes more precise data in demonstrating parameters that may represent reason for lack of control and GINA compliance.